Speedy recovery, early home! - Daily Physiotherapy benefits geriatric hip fracture patients

Introduction

Literature revealed that additional weekend and holiday Physiotherapy(PT) training is effective to improve functional recovery and reduce hospital length of stay in some patient groups. Strategic Service Framework(SSF) for Rehabilitation Services by Hospital Authority(HA) also stated the direction in providing rehabilitation service 7 day per week in selected patient group. One acute and one rehabilitation hospital in New Territories East Cluster(NTEC) launched the 7 day per week PT service for Geriatric Hip Fracture patients since 1st October 2017.

Objectives

To test the hypothesis that additional weekend and holiday PT training in in-patient phase might speed up the rehabilitation process for geriatric hip fracture patients.

Methodology

With a retrospective case-control study design, 355 geriatric hip fracture patients’ medical records were analyzed. Patients admitted Tai Po Hospital(TPH) in October 2017 to March 2018 were assigned as study group while patients admitted TPH in October 2016 to March 2017 were assigned as control group. Between-group comparisons were done on functional outcomes including Modified Functional Ambulation Category(MFAC), Elderly Mobility Scale(EMS), Modified Barthel Index(MBI) and length of hospital stay.

Results & Outcome

[Data shown in (study group vs control group) in mean±SD] For patients from acute hospital with 7 day per week PT training, better MFAC (3.17±1.05 vs 3.05±1.254,p=0.015) and MBI (47.35±19.63 vs 42.99±20.02,p=0.042), similar EMS (3.81±3.03 vs 3.96±3.65,p=0.518) were observed with similar post-operative acute hospital stay(7.69±3.87 vs 7.41±5.03 days,p=0.192). A higher percentage of day having PT training during rehab hospital stay was shown with the implementation of new service(89.1% vs 65.9%). Comparable mobility status at discharge was demonstrated by similar functional outcomes, in MFAC (4.35±1.27 vs 4.25±1.61, p=0.788), EMS (8.19±5.45 vs 8.44±6.06, p=0.998) and MBI (63.00±23.43 vs 61.17±26.08, p=0.743) with a significant shorter rehab hospital stay(19.99±5.51 vs 24.26±9.86 days, p=0.000) in patients with 7 days per week PT training. To conclude, additional weekend and holiday PT training is effective to improve functional recovery and reduce hospital length of stay for geriatric hip fracture patients.